Invasive Methicillin-resistant Staphylococcus aureus ABCs Case Report Form

Active Bacterial Core Surveillance (ABCs)

Documents and Forms

Document Name Document Type
Invasive Methicillin-resistant Staphylococcus aureus ABCs Case Report Form Form
Invasive Methicilin-resistant Staphylococcus Aureus ABCs Attachment 3_MRSA 2010 CRF.pdf Form
Attachment 8 2008_Invasive MRSA CRF Instructions_FINAL.doc Instructions for Invasive Methicillin-resistance Case Report Form IC Document

Information Collection (IC) Details

IC Title:	Invasive Methicillin-resistant Staphylococcus aureus ABCs Case Report Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Invasive Methicilin-resistant Staphylococcus Aureus ABCs Case Report	Attachment 3_MRSA 2010 CRF.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,090	6,090
Annual IC Time Burden (Hours)	2,030	2,030
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Instructions for Invasive Methicillin-resistance Case Report Form	Attachment 8 2008_Invasive MRSA CRF Instructions_FINAL.doc	08/11/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.